Because the enzyme MAO is necessary to break down tyramine and when this is restricted the increased levels of serum tyramine can result in severe hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias.

Major depression - these antidepressants are now first line for this disorder.

Anxiety

Eating d/o

Examples of SSRI's:

Fluoxetine (Prozac)

Sertraline (Zoloft)

Peroxetine (Paxil)

Citalopram (Celexa)

Escitalopram (Lexapro)

Side effects of SSRI's:

Sexual dysfunction

Weight gain

Overall this class of drugs has an excellent safety profile, heart toxicity is not observed and other less serious effects such as sedation, urinary retention, constipation, increased heart rate, hypertension and anticholinergic effects occur less often.

SSRI's

Onset of action is less than 4 weeks.

SSRI's

Serious side effect of SSRI's:

Serotonin sydrome!

Serotonin syndrome occurs when.....

patient is taking an additional medication that affects serotonin.

Symptoms of serotonin syndrome can occur 2-72 hours:

Mental confusion-agitation and anxiety

Hallucinations

Hyperreflexia

Muscle rigidity

Myoclonic jerks

Fever and tremors

Treatment for Serotonin Syndrome:

Discontinue SSRI

Provide supportive care

May be deadly

Severe cases may require mechanical ventilation and if left untreated this condition can be deadly.

Increased suicidal with antidepressants.

Increased energy with symptomatic relief.

Disease process

Precautions with prescribing: type of antidepressant, amount and follow up

Withdrawal symptoms:

Patients on most antidepressants and especially the SSRI's and SNRI's should be withdrawn from the drug over a period of 4 weeks.